Intracavernosal Injections (Penile Injection Therapy) Patient Information


Erectile Dysfunction or difficulty obtaining and/or maintaining an erection adequate for sex is very common and can be treated very successfully with a number of different therapies.

Sometimes simple measures like weight loss and exercise or a reduction in stress/anxiety are all that is needed to improve a man’s erections.  If these measures are not effective, you may be offered oral medications (Viagra, Levitra and Cialis), a vacuum device, penile injection therapy or a penile prosthesis to improve the erections.

There is also a new technique offered at the Men’s Health Institute using Low Intensity Shock Wave Therapy to improve the blood flow to the penis for men with erectile dysfunction.  Speak with your doctors about all of these options.

Penile injection therapy is a safe technique used to inject a small amount of medication directly into the penis.  These medications relax the muscles in the penis and increase the blood flow to the penis.  This increase in blood flow helps the men obtain and maintain the erections.

icon Before Using injection therapy ~

Some medications are NOT safe for persons with some conditions.  It is very important that you disclose ALL of your health issues and ALL your medications, vitamins, supplements and herbals products so your doctor can determine if this medication is safe for you.

iconWe have special concerns for individuals who have

  • diseases, previous injuries, surgeries or abnormalities of the penis.
  • problems with the urethra – the tube your urine comes out of.
  • been previously advised NOT to have sex.
  • problems with dizziness or fainting.
  • sickle Cell Disease.
  • bone marrow cancer or forms of Leukemia.
  • other medications in use for erectile dysfunction, including those NOT prescribed by their doctor.
  • had an allergic response to any of the medications in the injection.


Injection teaching

You will have a teaching session with our nurse specialist for teaching you the injection technique. This is a discussion as well as a teaching session. Please ask questions to improve your use of this medication. If you would like to bring your partner, they are welcome.

Common Problems Seen with Penile Injection Therapy

Most medications have effects that are unwanted. Many improve within an hour of taking the medication. See the list below for the most common and what you should do.

Painful penis or burning. It will pass, massage for longer than originally taught. If it doesn’t improve see us.
Prolonged and painful erection. See the important information at the end of this sheet.
Testicular pain, leg cramps. Not a serious concern, speak with your doctor if you are troubled by this
Headaches, dizziness. Do NOT drive or use power tools or equipment while dizzy. Move slowly can help. Not a serious concern.


If you are experiencing other symptoms and you think they are related to this medication, please speak with us and see your doctor.


What You Can Do

  • Keep your physician appointments.
  • Do NOT deviate from the dose plan set up for you or the teaching instructions.
  • Document your doses and their results, how you were feeling, any problems.
  • Discuss with us how to make changes that can help; weight loss, stress management, lowering alcohol consumption, smoking cessation, and couple counseling – all of these and others can make a difference.
  • Sometimes you may bleed at the injection site, this can increase your risk to sexually transmitted diseases. If you are concerned, talk with us about ‘safe sex’ practices.
  • Dispose of your used supplies responsibly. Every city has medical waste disposal centres. Check online for your town’s centre or your local pharmacy.
  • When buying other medications, always check with your pharmacist to make sure they are safe to take when using the injections.



Intracavernosal Self-Injection Technique

Simple Injection Rules to Remember When Using Penile Injection Therapy

  • Always inject within an inch of the base [the part of the shaft closest to your body]
  • Always inject on the side
  • Always alternate left side and right side for each injection. NEVER inject on the same side two injections in a row. You can cause scarring and curving of your penis. If you notice a curvature of the penis, please call and schedule a follow up appointment immediately.
  • Always massage the injection site and the penis after the injection to move the medication throughout the shaft.
  • Expect you may sometimes ‘hit’ a small blood vessel and have some bleeding at the injection site. Be calm, hold the site firmly for a minute while you still massage the medication into the shaft.
  • You may use the medication every other No more than one injection in a 24 hr period. No more than 3 injections in a week.

What you should know about this treatment:

  • The medication must be kept refrigerated in order to maintain effectiveness.
  • The goal is to induce an erection lasting 30-60 minutes. Please do not alter the dose of your medication without speaking with us first.
  • Incorrect technique may result in a partial or no erection. It does not cause any harm. You can try again on a different day if this occurs. If the response is still less than expected, call the office to discuss and adjust the dosage and technique of the injection.
  • The erection should never last more than two hours. If this does, it is called a priapism. See the important information at the end of this sheet.
  • Be sure to keep follow up appointments. We want to determine the effectiveness as well as examine for curvature or other issues that can arise. Opencommunication is the key to the safe and successful use of this medication.


Technique of Intracavernosal Injection:

  1. Wash your hands before starting the injection sequence.
  2. Wipe off the rubber stopper on the vial with alcohol swab.
  3. Pull back the plunger on the syringe (with only air) to the dose you were told to inject.
  4. Place the syringe/needle at a right angle into the bottle/rubber stopper.
  5. Hold the vial upside down and inject the air into the vial.
  6. Pull back the plunger on the syringe slowly to the dose you are to inject.
  7. Remove the syringe from the vial.
  8. Holding the syringe with the needle facing up in the air, tap the syringe to get any air towards the top of the syringe towards the needle. Now, push out any excess air from the syringe.
  9. Wipe off the penis where you are planning to inject with the alcohol swab.
  10. Hold the head of the penis with your “non injecting hand” and stretch the penis out fully.
  11. Place the syringe/needle into the corpora cavernosum as pictured below. Remember to stay close to the base of the shaft. Once you are sure you are in the corpora, inject the medicine slowly. The medication should be injected between the 2-3 o’clock position on one side and the 9-10 o’clock position for the other side.
  12. Remove the needle and apply pressure for 30 seconds.
  13. Then, massage the penis from the base to the tip approximately 5-10 times.


The penis should become erect (with the assistance of foreplay) in 10-15 minutes.


Intracavernosal Injection Disclosure:

  • Your urologist has discussed the treatment options for erectile dysfunction that include oral PDE5 inhibitors (Viagra, Levitra and Cialis), Vacuum Erection Devices (VED), Low Intensity Shock Wave Therapy, intracavernosal injection therapy, intraurethral suppositories (MUSE) as well as penile prosthesis placement. We want to be certain that you understand the risks of any and all treatments you may choose so you have made an informed consent.
  • Intracavernosal injection therapy involves the use of single medications such as Papaverine, Phentolamine, Prostaglandin E1 or a combination of medications called BiMix, TriMix or QuadMix.
  • This medication is injected directly into the side of the penis called the corpora cavernosum using a sterile syringe (typically an insulin syringe with an ultra-fine needle) and alcohol swab.
  • Since it is injected directly into the side of the penis, the potential side effects are typically local and mild. They include
  • Some pain/discomfort at the injection site.
  • Potential infection if sterile technique is not used.
  • Scarring, which can appear as a “lump” or curvature if you inject in the same location time after time.
  • A prolonged erection (priapism) that could cause irreversible damage and permanent loss of erections in the future.
  • A “black and blue” bruise if you inject through/into a vein on the superficial aspect of the penile skin. This usually goes away within a few days.

To reduce these potential side effects

Reduce infection:

  • Wash your hands before beginning the injection technique.
  • Disinfect the rubber stopper on the medication vial with alcohol before placing the needle into the vial to draw out the medication.
  • Use a new syringe for each injection.

Reduce Scarring, bumps, curvature, and discomfort:

  • After injecting the medication, apply pressure to the injection site for 30 seconds. Then, massage/milk the penis from the base to the tip ten times.
  • Remember to alternate sides for your injections. If you inject the right side now, use the left side for the next injection.
  • Do not use the medication more than every other day.
  • Do not increase your dose without first discussing with your doctor.

Instructions in case of a Priapism

What is a priapism? This is an erection lasting more than two hours. One can have pain and permanent damage (such as scarring, curvature and loss of erectile function) if left untreated.

What should be done if this occurs:

  • Take 120mg of Sudafed, wait and wait for 30 minutes. If the erection does not go down, take another 60mg of Sudafed and wait for another 30 minutes (do not do this if on blood pressure medication – if so, go immediately to your closest emergency department).
  • Try a cold compress around the phallus and gently squeeze to see if this will help.
  • Try walking or jogging for 15 minutes to see if this helps.

If these maneuvers do not work, go immediately to your nearest emergency department – Do not wait.  Also BRING your medication with you. ERs are very familiar with this, and have the medication on hand to relieve the priapism.